peds deck 9 Flashcards
cerebral palsy is a disorder of _____________ & ______________
motor ability; muscle tone.
80% of cases of CP are _________________; while 6% come from ____________, and can also be acquired after neurologic injury, most commonly from ______________
prenatally acquired; hypoxic injury at birth; meningitis
anesthesia implications for pt with cerebral palsy
- can be spastic –> difficulty with positioning 2. poor muscle tone (consider diaphragm and heart) 3. poor vascular tone 4. poor temperature regulation 5. commonly have seizures/epilepsy - AVOID MEPERIDINE 6. scoliosis common
anesthesia considerations for the pt with Autism spectrum d/o
- be careful of preoperative medications 2. discuss preop medications/distraction techniques with caregivers (i.e. find out what works for the child)
anesthesia considerations for the pt with epilsepsy
- consider their at home medications 2. careful with preop medications 3. want them to take seizure meds DOS 4. metabolize medications (may need to redose NMBA more frequently) 5. NO MEPERIDINE
there are _________ types of spinal muscular atrophy and are classified by _____________
5; onset of sx
why do pts with spinal muscular atrophy commonly present for surgery?
- G-tubes 2. eventually need trach and become vent depedent
T/F: pts with spinal muscular atrophy are NOT neurologically intact
FALSE
pt presents for surgery and has Duchenne’s MD, what is the risk you should be concerned about
MD, specifically Duchennes can trigger MH crisis; plan for non-triggering anesthetic
pt comes in with Muscular dystrophy, but does not know they type, and it is not indicated in the chart, what should you plan for?
non-triggering anesthetic
how would you do a non-triggering anesthetic for the pt at risk for MH? (duchennes MD)
- flush machine according to manufacturers recommendation 2. utilize charcoal filters 3. ensure no succinylcholine is out 4. tape volatile agents
_______________ is the absence of parasympathetic ganglionic cells in the bowel –> may result in needing bowel resection
Hirschsprungs
Risk factors for the development of persistent pulmonary htn of the newborn
- birth asphyxia (most common) 2. maternal use of prostaglandin inhibitors near term (NSAID, ASA) 3. Diaphragmatic hernia 4. microthrombus
_________________ is associated with increased muscularization of pulmonary arterial vessels, sepsis, and aspiration syndromes
persistent pulmonary htn of the newborn
diagnosing persistent pulmonary htn of the newborn
- echo = shunting across PDA; tricuspid regurg 2. holosystolic murmur 3. hx by interview that indicates: meconium aspiration, abnormal FHR monitor 4. sx: cyanosis, respiratory distress with tachypnea but minimal retractions 5. lg shunt: PAO2 gradient > 20 mmHg
goals in treating persistent pulmonary htn of the newborn
- decrease PVR 2. improve oxygenation 3. correct acidosis 4. correct myocardial dysfunction
tx for persistent pulmonary htn of the newborn
- tx underlying cause 2. high frequency jet ventilation (HFJV) 3. Nitric Oxide (mainstay of therapy) 4. sildenafil (pulmonary VD) 5. inotropes 6. if HFJV & NO fail = ECMO
what is the only therapy/tx for severe combined immunodeficieny d/o (SCID)
stem cell transplant
__________________ is where both T cell and B cells are very low or absent causing infants to have recurrent and severe infections
severe combined immunodeficiency (SCID)
which pediatric d/o are autosomal recessive
- Hurlers 2. Cystic Fibrosis 3. Spinal muscular atrophy
which pediatric D/o’s are autosomal dominant
- Crouzons 2. Apert 3. Treacher Collins (40% - less common)
new mutation is the most common presentation of __________________ & ________________
apert syndrome; Treacher Collins (60%)
______________ blood flow = parallel circuit with both LV and RV sending oxygenated and deoxygenated blood, mixing with shortcuts
prenatal (in-utero)
_______________ blood flow = serial circuit with two pumps (LV and RV) and two different systems (cardiac and pulmonary)
postnatal
the ductus arteriosus closes in 98% of term infants by day ____________
4
after birth the foramen ovale is _____________ closed due to increased pressures in the left side of the heart; however, remains _____________ open in 50% of children < 5 and in 25-30% of adults
functionally; anatomically
CO in the neonate is ____________ dependent
HR
T/F: SV in the neonate is fixed
TRUE
PVR _____________ after birth until around 6 mo of age - where it reaches adult levels
decreases
what increases PVR
- PEEP 2. high airway pressures 3. atelectasis 4. low FiO2 5. respiratory & metabolic acidosis 6. increased hct 7. SNS stimulation 8. direct surgical manipulation 9. vasoconstrictors: phenylephrine
what decreases PVR
- no PEEP 2. low airway pressures 3. lung expansion to FRC 4. high FiO2 5. respiratory & metabolic alkalosis 6. low hct 7. blunted stress response (deep anesthesia) 8. Nitric Oxide 9. Vasodilators: milrinone, prostacyclin
_______________ shunt is when deoxygenated blood from systemic veins flows directly into aorta –> recirculation of deoxygenated blood in systemic circulation
right to left
_____________ shunt is when oxygenated blood from pulmonary veins –> PA –> recirculation of oxygenated blood within the pulmonary circulation
left - to - right
interventions to decrease shunt
- decrease stress 2. keep them warm 3. keep them appropriately hydrated (according to comorbidities/heart pathology)
what are some examples of single ventricle d/o
- hypoplastic left heart syndrome 2. pulmonary atresia with intact ventricular septum 3. tetralogy of fallot with pulmonary atresia 4. interrupted aortic arch
_______________ will cause mixing of systemic and pulmonary blood causing mixed blood to go into both systemic and pulmonary circulations
single ventricle
EKG considerations in the pediatric pt
- no change in P wave 2. PRI increases with age 3. QRS-interval increases with age 4. shift from R-axis to L-axis QRS 5. t-wave inversion in V4R, V-V4 from 1 week-adolescents
CO in the infant is __________x that of the adult at rest
2
what is a normal CO in the child
200 ml/kg/min - 325 ml/kg/min
the increased CO in the child reflects higher __________ and ____________
BMR; O2 consumption
__________________ is when the SVC and IVC are surgically connected directly to the pulmonary artery without a pumping chamber
fontan
Fontan procedure is commonly performed for what disorders
- single ventricle (originally developed for this) 2. tricuspid atresia 3. HLHS
with fontan circulation, pulmonary blood is driven by _______________ pressure gradient, thus need adequate ___________ and decreased ____________
nonpulsatile; preload (volume); PVR
anesthesia implications for fontan
- adequate preload 2. decreased PVR
what medications can you use in the transplanted heart if the pt is hypotensive
- epinephrine 2. isoproterenol 3. dobutamine
caution the use of ______________ in the transplanted heart due to risk that heart may not start back; also caution ____________ due to risk of severe bradycardia
adenosine; neostigmine.
anesthetic considerations for the pt with hypertrophic cardiomyopathy
ensure they are adequately hydrated (i.e. increase preload)
anesthesia considerations in the pt with kawasaki dz
careful consideration and balance between myocardial oxygen supply and demand
which pediatric patients DEFINITELY get endocarditis abx prophylaxis
- prosthetic valves 2. hx of infective endocarditis 3. unrepaired cyanotic congential heart disease (incl palliative shunts and conduits) 4. completely repaired defects repaired with prosthetic material for 6 months after procedure 5. cardiac transplant pts with valve regurg)
if child is recieving endocarditis abx prophylaxis the dose will be __________x their normal dose; however it should NOT exceed ____________ dose
2; adult
